Community-Based Intergenerational Oral Health Promotion in Rural America Abstract The overall specific aim is to conduct a community randomized trial using brief motivational interventions to increase utilization of preventive dental care and improve the oral health of rural, low-income pregnant and postpartum women and their children and to increase the number of oral health practices taken by these women to prevent caries in their young children. The primary outcome measure for the trial will be mothers' untreated dental decay. There are two additional components in this study: (1) formative research, refinement of intervention protocols, and training of interventionists, and (2) dissemination with corresponding sub-specific aims: 1a. To use qualitative methods within three groups of community stakeholders (low-income pregnant and postpartum women, public health personnel, and health professionals) to facilitate planning and refinement of the interventions to enhance dental utilization and self-care. 1b. To establish a training site in the community to enhance implementation of intervention protocols in the intervention counties. 2. To disseminate information about the outcomes of the intervention and to provide technical assistance, training, and approaches for sustainability to health care providers and public health personnel to extend the benefits of this study. The study will utilize a two-group, community randomized trial design in 8 intervention counties. Non-participating counties (N=4, 400 women) will provide comparison oral health and utilization data and serve as controls. Randomization to the interventions will occur at the county level; intervention implementation will be done in two waves (counties 1-4 then counties 5-8). The two interventions are: (1) Self-Instructional Motivational Materials (SIMM) (N= 4 counties, 400 women) will involve the use of materials that motivate and provide choice among community-recommended strategies to utilize preventive dental services and engage activities to prevent tooth decay; (2) Brief Motivational Interviewing (Brief Ml) (N= 4 counties, 400 women) will include these motivational materials as well as brief counseling and follow-up provided by local trained women. This research concerns oral health of mothers and children in rural communities. Our approach, based on scientific excellence and community collaboration, is innovative as it focuses on the need for an intergenerational approach (mother and child as opposed to child alone) to using care and preventing tooth decay in a low-income, rural population.